• Alexandra L Potter, Allison L Rosenstein, Keervani Kandala, Shivaek Venkateswaran, Mathew V Kiang, Olugbenga T Okusanya, Hugh G Auchincloss, Linda W Martin, Yolonda L Colson, and Jeffrey YangChi-FuCFDivision of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass. Electronic address: cjyang@mgh.harvard.edu..
• Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass.
• J. Thorac. Cardiovasc. Surg. 2024 May 1; 167 (5): 16031614.e91603-1614.e9.

ObjectivesTo evaluate whether there is a shortage of thoracic surgeons in the United States and whether any potential shortage is impacting lung cancer treatment and outcomes.DesignUsing the US Area Health Resources File and Surveillance Epidemiology End Results database, we assessed the number of cardiothoracic surgeons per 100,000 people and the number of stage I non-small cell lung cancer (NSCLC) diagnoses in the US in 2010 versus 2018. Changes in the percentage of patients diagnosed with stage I NSCLC who underwent surgery and stereotactic body radiotherapy and changes in overall survival of patients with stage I NSCLC from 2010 to 2018 in the National Cancer Database were evaluated using multivariable logistic regression and Cox proportional hazards modeling.ResultsFrom 2010 to 2018, the number of cardiothoracic surgeons per 100,000 people in the US decreased by 12% (P < .001), while the number of patients diagnosed with stage I NSCLC increased by 40% (P < .001). Over the same period, the percentage of patients who underwent surgery for stage I NSCLC decreased from 81.0% to 72.3% (adjusted odds ratio, 0.59; 95% confidence interval, 0.55-0.63); this decrease was similarly seen in a subgroup of young and otherwise healthy patients. Greater decreases in the percentage of patients who underwent surgery in nonmetropolitan and underserved regions corresponded with worse improvements in survival among patients in these regions from 2010 to 2018.ConclusionsRecent declines in the US cardiothoracic surgery workforce may have led to significantly fewer patients undergoing surgery for stage I NSCLC and worsening disparities in survival between different patient populations.Copyright © 2024. Published by Elsevier Inc.

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